Cochrane corner: implantable loop recorder versus conventional workup for unexplained recurrent syncope

Solbiati, Monica; Casazza, Giovanni; Dipaola, Franca; Sheldon, Robert S.; Costantino, Giorgio

doi:10.1136/heartjnl-2016-309980

Cited by 6 publications

(4 citation statements)

References 9 publications

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“…That study examined 570 patients without a definitive diagnosis despite undergoing 237 A study with a larger number of patients (n=201) found the diagnostic usefulness of the ILR was significantly high, with a hazard ratio of 6.53. 238 A meta-analysis showed similar findings, 239 suggesting that an ILR should be considered in the early stage of frequent syncope of unknown origin. Similarly, in Japan, a study reported a high diagnostic rate of 56% using ILRs, despite being a single facility study.…”

Section: ▋ 53 Indicationsmentioning

confidence: 78%

JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia

Takase,

Ikeda,

Shimizu

et al. 2024

Circ J

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Section: ▋ 53 Indicationsmentioning

confidence: 78%

JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia

Takase,

Ikeda,

Shimizu

et al. 2024

Circ J

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“…A head‐up tilt test is positive in only a third of patients with unexplained syncope, and is non‐specific because susceptibility to orthostatic stress occurs in a variety of conditions (Flevari et al ., 2009). The most sensitive and specific test for the diagnosis of ictal syncope is prolonged VEM (Schuele et al ., 2007; Nguyen‐Michel et al ., 2014; Bestawros et al ., 2015; Tényi et al ., 2017) and for cardiac syncope is ILR (Solbiati et al ., 2016; Padmanabhan et al ., 2019). The recent European Society of Cardiology guidelines for evaluation and management of syncope recommends ILR in the early phase of evaluation of people with unexplained recurrent syncope (Brignole et al ., 2018) However, VEM and ILR may not be widely available, especially in developing countries, and many patients may not be able to afford the cost.…”

Section: Discussionmentioning

confidence: 99%

Comparison of clinical and electrophysiological characteristics between ictal and cardiac asystole encountered during video‐EEG monitoring

Sankaranarayanan

Makhija

Gopinath

et al. 2019

Epileptic Disorders

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Aims . Differentiation between syncope secondary to epileptic seizures and cardiac disease in patients displaying transient loss of consciousness associated with convulsive movements is a diagnostic challenge both for neurologists and cardiologists. In such patients, prolonged video‐EEG monitoring not only helps in identifying asystole as the cause of syncope, but also in categorizing asystole as primarily cardiac in origin (cardiac asystole) and secondary to epileptic seizures (ictal asystole). We carried out this study to ascertain the prevalence of asystole in an epilepsy monitoring unit, and to contrast the clinical and electrophysiological characteristics between ictal asystole and cardiac asystole. Methods . Through a retrospective search, we identified patients who were shown to have had asystole using a database of patients who underwent prolonged video‐EEG monitoring during a 68‐month period. We compared the data of 18 consecutive patients; five with ictal asystole and 13 with cardiac asystole, with 121 and 64 events recorded from them, respectively. Results . Of the 10,096 patients who underwent prolonged video‐EEG monitoring during the study period, we identified 18 (0.17%) patients with asystole. Cardiac asystole was 2.6 times more frequent than ictal asystole. Older age at onset, heralding symptoms of presyncope, occurrence during wakefulness, and brief duration of the events supported the diagnosis of cardiac asystole. Ictal asystole events were more protracted, and prolonged asystole more frequently occurred in patients with extratemporal seizures compared to temporal lobe seizures. Asystole occurred in only half of the recorded seizures. Conclusions . The accurate categorization of asystole as seizure‐related or heart disease‐related has huge implications for management strategy and outcome. The necessity of permanent pacemaker implantation is more frequent and urgent in patients with cardiac asystole because of the greater risk of sudden death. Hence, in patients with an ominous diagnosis of cardiac asystole, a thorough cardiac evaluation should surpass neurological evaluation.

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“…2 He summarised the available investigations for cardiac syncope, with the implantable loop recorders being most useful and cost effective compared to standard investigative tools. 3 Dr Chris Skene (Wythenshawe Hospital) discussed the clinical approach to palpitations and the key features in history that help differentiate between different causes of palpitations. He defi ned the 'red fl ags' that one should identify and also summarised new modalities of cardiac rhythm monitoring.…”

Section: Session 1: Clinical Cardiology: Learning From Experiencementioning

confidence: 99%